Frequently Asked Questions about Breast Augmentation

Our aim is to make each of our client’s experience as relaxed, well-informed and comfortable as possible. Not only does this come through a high-level of service, personalised to meet individual needs, we believe a deep understanding of the service we offer is crucial to choosing the right path.

Below we have included answers to the most commonly asked questions we face. If you would like further information or have a question not mentioned, please contact us directly for more information.

Saline Or Silicone?

Many women’s first question is, which type of breast implant is right for me? Choosing an implant for your enhancement surgery is essential but can often get overwhelming or unduly complicated. Whether you pick silicone or saline implants, both are durable, elastic and resilient options and their shells are specially designed to resist ruptures and tears.

Have a look at our comparison chart before deciding on which type of implant works best for you.

Benefits of Cohesive Silicone Gel Implants

  • Cohesive gel implants are FDA (Food and Drug Administration) and Health Canada approved
  • Each implant is filled with a thick, cohesive silicone gel formula that holds the design together uniformly. The gel formula also retains a natural pliability and flexibility which closely resembles the natural breast tissue
  • Cohesive gel implants suffer from less rippling or wrinkling than those made of saline
  • Ideal for women with very little natural breast tissue or fat
  • If a cohesive gel implant leaks or ruptures, the silicone gel will not spill out
  • Each implant has a set filling volume for predictable results
  • To ensure longevity, all cohesive gel implants are covered by a generous manufacturer warranty and lifetime replacement policy, free of charge: Allergen Confidence Plus Premier Warranty and Mentor Premier Advantage Limited Warranty

Benefits of Saline Breast Implants

  • Saline implants have been FDA and Health Canada approved for many years now
  • Each implant is filled with a sterile saltwater solution, similar to the fluid that makes up most of the human body (i.e. It’s natural and harmless)
  • Saline implants generally have a slightly firmer feel than those made of silicone
  • All saline implants have a flexible fill volume that can be customized and precisely adjusted by Dr. Jugenburg during surgery for client personalized results
  • Ideal for women with slight breast asymmetries
  • If a saline implant ruptures it will be completely harmless and immediately visible since the proportions of the shape will change instantly
  • Incisions performed for saline implants are significantly smaller in size than those for silicone implants
  • Saline implants are cheaper in price than those of silicone, which means the total procedure cost for saline implant augmentation is overall lower for the patient
  • All saline implants are covered by a manufacturer warranty and lifetime replacement policy: Allergan Confidence Plus Warranty and Mentor Standard Advantage Limited Warranty

How to choose the correct breast implant size

Many women struggle to decide which cup size they want to be. Returning a TV because you don’t care for the quality is one thing, but it’s a whole other story when it comes to breast implants.
When it comes to breast augmentation surgery, deciding whether to opt for silicone or saline is not the only consideration patients must think about. Size and measure is often the biggest choice.

Can I Get Online Advice?

There are many online sites out there that are excellent information resources for patients. Some also allow patients to ask questions, such as, for example, Realself.com where patients can post questions and expert surgeons then answer these questions. Unfortunately, asking experts for an online opinion is not the way to go.

It is truly impossible to give you a recommendation on what implant size to choose online. Every patient should take time with their cosmetic plastic surgeon to clearly describe what it is that she wants to achieve.

Why Seek a Professional Consultation

While perhaps the most common question asked, there is never a quick answer to which implant size is best for you.

Understand that because each person is different and the same implant on two different people can look very different, it is impossible for us to tell you what implant is best for you without properly examining you and measuring you.

Without accurate measurements, the results can also fall a long way short of a desired look. Using only a photo, there is a huge leap of faith which relies only on perception. This is something which never ends well. In taking a professional consultation which includes an examination, a true understanding can be formed to base an action plan.
It also allows patients to try on different sizers and then make a decision. The direct communication from a personal appointment is also imperative to form a clear and accurate plan. Dr. Jugenburg and our staff need to understand what size and shape you want to achieve. Something which is a very important step in our consultation.

Should You Bring Photos of Breasts That You Like?

YES – but not because we promise to create that exact same breast for you (that would be impossible) but because it allows us to better understand what you like and don’t like.

Dr. Jugenburg will then review these pictures with you and let you know whether it is realistic to aim for that particular look. For example, we sometimes have a heavier woman with sagging breasts who brings in pictures of large perky breasts on a skinny young woman. To go from one to the other requires a lot more than simply putting in large implants, often involving multiple steps. As such, this would have to be discussed with you to avoid disappointment on your part.

If the world’s best plastic surgeon performs the very best possible breast augmentation for you, given your existing anatomy, there is still a small margin of unpredictability. If the results are not exactly what you hoped for, you will not be happy. A proper in-person assessment and planning session is crucial to creating happy patients and why we strive to provide realistic answers.

Is Fine-Tuning Possible?

For this reason, some doctors are now recommending adjustable breast implants. Any women who are genuinely unsure just how much bigger they would like to be, these implants offer an option which can provide piece of mind. It’s not uncommon for women to initially choose a breast implant size but then after a few months feel like they would favour having larger implants. With these adjustable breast implants, we have the luxury of coming in three months later and asking if they would like a variation.

Instead of deciding on a size before the surgery and hoping for the best results, doctors who use adjustable implants place a small port that connects to the implant underneath the skin. If the patient decides to go a little bit bigger, the plastic surgeon injects additional saline into the implant. If she wants a little less volume, the doctor can remove some.

How Much Can They Be Changed

With adjustable breast implants, you can modify the implant size postoperatively by up to 20 percent of its original size. It’s a great way to control the breast size after the original augmentation surgery as people often tend to change their minds.
Modifications can be made when the initial swelling subsides, around three months after the surgery, until about six months post-surgery. At that point, the port is removed through an outpatient procedure done under a local anaesthetic.

The adjustable implant consists of a “port” that allows the surgeon to inject more volume into the breast implant or remove volume, as requested by the patient. Then the surgeon takes the patient in front of a mirror and inflates the implant to the desired size, and can adjust the implant over a period of weeks.

Worries About Scarring

Do you want breast augmentation but are afraid of the scars? You’re not alone! Pain and scars are the two biggest obstacles patients fear when considering cosmetic surgery.
There is no way to place a breast implant without leaving a scar, HOWEVER, a skilled plastic surgeon is able to do it in a way that will hide those scars incredibly well.

Minimal scarring is a necessary trade-off for augmentation. Although an incision scar will appear, a well-healed scar will fade to virtually invisible over time. I generally tell my patients that scars will take a full year to mature.

A board-certified plastic surgeon will also follow certain principles to minimise scarring:

  • Choose a sufficient incision length for pocket access and implant insertion
  • Reduce trauma to the skin edges during surgery
  • Choose the right incision placement to reduce tension or stretch on the incision
  • Use delicate incision closing techniques to minimize tension on the skin

Following these principles will produce high-quality scars (i.e. they will barely be visible)

Nevertheless, scarring predominantly depends on 2 things – Incision placement, and incision length. As no two patients are alike, it’s important to individualise the surgical plan for each patient’s specific needs.
There are three main incision options which are: inframammary, transaxillary, and peri-areolar. Each have their own merits as detailed below but the best incision should minimise scarring, allow safe pocket creation, and permit a safe implant insertion.

Inframammary Incisions

This is carried out in the breast fold and is the most widely used incision site.

Specific advantages include:

  • Provides great amount of direct vision and surgical control on variables like bleeding.
  • There is less trauma to surrounding tissues (e.g., breast tissue, milk ducts, critical nerves, and blood vessels) during pocket dissection and implant insertion
  • All types of implants can be inserted through this approach
  • In case revision surgery is required in patient’s lifetime, a new incision is not required
  • Allows controlling of the inframammary fold to provide a natural look

Disadvantages include:

  • A presence of the scar on the aesthetic unit of the breast
  • Not suitable if there is areolar asymmetry or areolar herniation as there is in the tuberous breasts
  • It is best suited for patients who have a small areola (dark pigmented skin around the nipple), patients with breast sagging, and those who require large volume implants or form-stable implants

Transaxillary Incisions

The axillary incision approach is most suitable for patients who have great concerns about having a scar on the breast, by placing the scar on the armpit instead. The axillary approach requires patients have sufficient breast tissue and normal breast shape. This approach can also be used if the patient has a small areola or only requires small silicone or saline implants. In fact, this is ideal for patients with very youthful-appearing breasts, especially younger women with no history of pregnancy and those who have smaller, perkier breasts.

Specific advantages include:

  • Lesser trauma to surrounding breast tissues while dissecting an implant pocket
  • With the proper no-touch technique using the Keller Funnel, the rate of capsular contracture is very minimal

Disadvantages include:

  • This approach only provides direct visual access to the upper half of the implant pocket and full vision dissection requires an endoscopic camera
  • Critical nerves and blood vessels near the armpit can be injured if excessive dissection is done
  • If re-operations are required, an additional incision using the inframammary or peri-areolar approach is required to optimize control and accuracy
  • The axillary approach is not good for patients with tuberous breasts, constricted breasts, or with severe sagging
  • This approach has an increased risk for implant malposition in the upper pole of the breast because of poor visualization of the inframammary fold
  • Great caution is required to prevent trauma to lymphatic vessels which are part of our immune system

Peri-areolar Incisions

In this approach, the incision is made around the areola (the dark pigmented skin around the nipple) and carried directly through the breast tissue. Even though this approach gets used less often, it can be very useful to avoid a scar in the fold of the breast. This is especially true if there is distinct border and colour difference between the areolar skin and the surrounding breast skin. This will allow the scar to be concealed within the dark pigmented areola.

Specific advantages include:

  • Excellent access for direct vision and control surgical variables and pocket dissection in all areas
  • Easier correction of areolar asymmetries, deformities, or nipple-areola malpositions
  • All types of implants can be placed given the diameter of the areola is adequate
  • There are very few critical nerves or blood vessels in close proximity to the incision site

Disadvantages include:

  • Form-stable silicone gel implants are more difficult to place with greater risks of implant damage
  • Breast tissue is dissected resulting in more trauma comparatively
  • During insertion, the implant is exposed to breast tissue bacteria resulting in higher rates of infection and capsular contracture.
  • Breasts are more likely to face interference with breastfeeding and sensation
  • Great care is needed to maintain blood supply to the nipple-areolar complex
  • The approach is not suitable for those with small areolas as it will put limitations on vision, control, and implant insertion
  • The scar is located on the most visible portion of the breast
  • Because dissection is made through the breast tissue, there is a risk of the implant herniating through the breast tissue tunnel.

When deciding on the incision placement, you have to consider your own preference, the surgeon’s skill in the specific approach, and the degree of visibility and control over surgical variables and pocket dissection.

The incision should also allow insertion of the implant without any damage or contamination to the implant or any damage to the surrounding breast tissue. In the end, you must collaborate with your surgeon to select the incision approach that best suits your body and your needs.

Incision Length

Irrespective of where the cut is made, the incision length is the second factor that influences the scar. This is also further related to the implant type and size of implant chosen to use.
Many surgeons try to attract patient with claims over “shorter scars” but the truth is that a smaller incision decreases the surgeon’s field of vision. This makes surgical manoeuvres and insertion of pre-filled silicone implants much more difficult resulting in poor quality scars compared to longer scars.
Of course, no surgeon will want to make an excessively long incision, or else you will not be happy with your results.

How long Is A Standard Incision

Incisions with silicone round implants have to be around 4-6 cm. For anatomical cohesive silicone implants, this will need to be slightly larger. By comparison, incisions can be made around 3.5-4.5 cm for saline implants because they are not pre-filled but rather inflatable. There is always the option of having your implants inserted through the Keller Funnel which is the technique I use to reduce the length of the required incision.

On a side note, any incision less than 3.5 cm is a set-up for more trauma, scars, re-operations, and damage to the implant. Longer incisions are always preferable to short incisions that subject the implant to much greater pressures during insertion.

How Obvious Is The Scarring Directly After Operating

With regards to concerns of a scar showing in your swimsuit, either the inframammary incision or the peri-areolar incision could do to some small extent. The transaxillary incision will be visible under your armpit though, especially when you lift your arms.

The inframammary incision is usually not visible when standing or sitting upright, and because the incision will be placed just above the fold, it will be facing down making it less noticeable. It is also less likely to be under tension as this region does not tend to stretch or be raised. IMF scar will be hidden in bras and even under triangle-top string bikinis and is only visible up close when the breasts pulled upwards revealing the breast fold.

However, if you make raised scars, they may be visible beneath the tight shirt or through a bathing suit in both cases of periareolar or inframammary.

Treatment of abnormal scars

Let us suppose you have raised scars. In which case, there are many things you can do to improve your scar. You may:

  • Gently massage it using a lubricating cream containing Aloe Vera and Vitamin E for 6-12 weeks
  • Use a topical skin solution that contains a silicone solution such as a scar guard
  • Avoid wearing underwire bras, exposure to direct sunlight on the incision, or exercises that will stretch the incision area

Of course, you should also regularly see your surgeon for follow-ups. In more serious cases, steroid injections or steroid-containing skin tap can be used to flatten raised scars. Because of the potential steroid side-effects, Intense Pulsed Light can be effective at reducing redness in wounds.

How To Get Natural-Looking Breast Enhancements

There is actually a set of criteria which can be applied to determine if breasts carry a natural look. If your breasts meet these ideals, technically they will comply with our perceptions of a natural aesthetic. These characteristics are:

  • Upward pointing nipple, typically angled at 20 degree
  • A slope in the upper pole of the breast
  • A tight curvature (convexity) in the lower pole of the breast (i.e. below the nipple)
  • An upper pole to lower pole ratio of 45:55 (i.e. the percent of fill below the nipple should be 55% compared to 45% above the nipple)

Which Implant placement will give you most natural looking results

The decision to go behind the muscle or above the muscle has to do with the amount of soft tissue coverage. This is generally referred to as the “padding” beneath the skin. Choosing a pocket that is tight with sufficient soft tissue coverage prevents implant visibility, palpability, and risks of excessive stretching on the breast. It also stops excessive implant movement into the outer or inner sides of the breasts.

A hand-in-glove fit for the implant allows for a natural and long-lasting result. Your surgeon will do a pinch test in the upper pole of the breast to see how much “padding” you have. If you have less than 2 cm, then you do not have much padding and it would be best to go under the muscle.

Generally speaking, if your ribs are visible under the muscle, then you do not have much “padding.” If however, you have more than 2 cm, then you have the option to go over the muscle or under the muscle.

So which pocket allows a more natural look?

There is still a difference of opinion in the world of cosmetic medicine. If we are trying to meet those ideals described above, then under the muscle (partially sub-muscular) is the best option. This is because the muscle helps to maintain a slope for the upper pole while allowing for a curvature in the lower pole. Going over the muscle, by comparison, will just make your breasts appear round and augmented.

Like most aspects of breast augmentation, these decisions need to be tailored to your breast specific characteristics. If you are hoping to fully preserve the functionality of the pectoralis major muscle due to athletics or bodybuilding, or if you have a shapeless, constricted, tuberous, sagging breasts or do not have a proper cleavage, then over the muscle may be a better option.
Over the muscle (sub-glandular) implant placement may cause tissue wasting, interference with mammography, hold a higher risk for capsular contracture and synmastia (disappearance of the cleavage gap). These are just some of the reasons why many surgeons recommend behind the muscle (partially sub-muscular) placement.

Remember, there are many factors which go into creating natural-looking breasts. It is only through a combination of the correct choices particular to your body which will achieve your desired result. Some of these factors which need to be considered include:

  • The size of the implant – a large implant that exceeds your breast boundaries overly stretches your breasts. If too round it will make your breasts look unnatural and increase the likelihood of bottoming out (i.e. the nipple sitting too high on the breast, potentially with an empty upper pole), double bubble deformity, implant malposition, implant visibility, breast sagging, and breast tissue wasting. So going big is good but going beyond your limits will get you into big trouble…pun intended.A board-certified surgeon will always determine a suitable range for the implant volume after conducting basic breast measurements. These include breast base width, the amount of skin stretch, nipple to breast fold distance under maximal stretch, skin quality, and chest wall asymmetries. Each of these factors will be carefully considered. For example, if your breast base is very wide, we will require a higher implant volume to avoid the “rock in a sock” appearance.
  • The profile of the implant – How much the implant protrudes or sticks out in the forward direction is also important This influences how much stretch is put on the overlying breast skin. Excessively stretching the skin results in negative consequences and is something which must be avoided.
  • The shape of the implant – The majority of surgeons prefer round and smooth implants. If your breasts don’t have a natural shape to begin with, such as patients who have tuberous breasts, then you may require the use of anatomic implants. These are shaped with a lower half which is more loaded in volume than the upper half. This provides the desired natural look after they’ve been inserted.
  • Incision placement – The location of the incision determines the degree of trauma to the breast’s soft tissues, exposure of the implant to breast’s endogenous bacteria, pocket visibility and control, and also the implant’s position vertically and horizontally relative to the chest wall.
  • For example, compared to the tranaxillary (armpit) or the areola (around the nipple) incision, the inframammary (IMF) incision better allows your surgeon to lower the inframammary fold to increase its distance from the nipple. In many patients, the inframammary fold needs to be lowered in order to allow the implant to rest at a level which appears natural, and in order to prevent the appearance of excessive upper pole fullness.

Is Smoking Bad for Breast Augmentation

In a word…. Yes.

Smoking cigarettes, cigars, weed or anything else related is a dangerous thing to partake in when you’re involving breast augmentation or any other form of surgery. We all know that smoking alone causes lung cancer, however, there’s a lot more to it than just this.

Did you know, the smoke from a cigarette contains many toxic chemicals that interfere with your body’s ability to heal properly? Two of the many chemicals which inhibits recovery are carbon monoxide and cyanide.

How Smoking Hinders Recovery

Carbon monoxide binds with the haemoglobin in your red blood cells, preventing haemoglobin from carrying Oxygen molecules to your cells. In a way, you’re literally suffocating your cells at a molecular level.

Cyanide is also an alarming chemical. It’s a poison which enters your cells and stops your cellular mechanisms using oxygen to generate energy. This has the same effect as pouring a pollutant into the gas tank of your car. Even though you may have gas in the tank, the engine fails and the car eventually winds down and dies. In the same way, your cells stop producing their energy and will die.

It takes at least two weeks to clear the majority of these chemicals, and their side-effects, from the human body. This is why we ask all our patients to stop smoking at least two weeks before surgery and for at least two weeks after. Not even a single cigarette.
We require all of our patients to sign a consent form, asserting an understanding of the risks of smoking and stating that if they smoke, they will not hold us responsible for any smoking-related complications.

The Dangers Of Smoking

Smoking cannabis is also not recommended. Aside from the smoke itself, marijuana affects your body in a way that makes it less sensitive to anaesthesia and pain medications. In other words, someone who smokes cannabis requires 2-3 times as much anaesthetic than a non-smoking person. As a result, people who smoke illegal drugs are more likely to experience worse pain after surgery since pain medications are not as effective.

According to the American Society for Aesthetic Plastic Surgery (ASAPS), breast augmentation remained the most popular surgical procedure performed by plastic surgeons last year, with more than 318,000 individuals undergoing the surgery.
If you are one of these people, you are spending thousands of dollars to get a new and beautiful chest. Don’t ruin it by engaging in the act of smoking.